triss method
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ACCURACY OF TRISS METHOD IN DETERMINING SURVIVAL PATIENTS WITH MULTIPLE TRAUMA IN
DR.WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR.
Nuralim Mallapasi
Thoracic Cardiac and Vascular Dept Faculty Of Medicine Hasanuddin Univ
Makassar South Sulawesi Indonesia
Background
advances in technology and human civilization,
the higher mobility of individuals,
the risk of traffic accidents and workplace accidents such as trauma
violence between individuals or citizens
Talwar S, about 3.3 million people per year due to traffic accidents and 48,000 people died.
1986 in Indonesia 2.5 million people suffered from trauma and 10000 died from traffic accidents.
1992 Indonesia: Health Survey household Trauma
out of 15-24 age group is the first order;
age group 25-45 years old ranked as second;
majority of trauma patients are productive age group
of 15-45 years old
in some developed countries have developed an
assessment of trauma system ;
trauma score is a system used to assess the
anatomical and physiological damage
currently the most widely used is the combined scoring of
anatomical and physiological scoring
TRISS (Trauma Score and Injury Severity score) and ASCOT
methods (a characterization on trauma severity)
TRISS method using AIS score (abreviated Injury Scale) as
an anatomic score, then calculated to be ISS (injury severity
scale);
physiological scoring on TRISS method is RTS (revised
trauma score)
This study used the TRISS method to assess the probability
of survival
Trauma Score System
Anatomical score
Abbreviated Injury Scale (AIS)
Injury Severity Score (ISS)
Physiological Score
Glasgow Coma Scale (GCS)
Revised Trauma Score (RTS)
Combination of both
Pediatric Trauma Score
Trauma Score and Injury Severity Score (TRISS)
TRAUMA SCORE AND INJURY SEVERITY SCORE
TRISS is a combination of physiological and
anatomical trauma score (RTS + ISS)
TRISS assess the likelihood survival of patients
TRISS assessment is done by combining RTS,
ISS, patient age and whether the mechanism of
blunt or penetrating trauma to determine
PROBABILITY OF SURVIVAL =PS
TRISS using the formula:
PS=1 / ( 1+e )
b = 0,5600+0,7281 (RTS) – 0,1132 (ISS) + (-0,8339) (age)
e = equivalent with 2,7182
Age : < 55 YO = 0 > 55 YO = 1
b0 - b3 is coofisient obtained from regression analysis on a data set of trauma network
TRISS is important to understand that only a mathematical calculation rather than an absolute measure in assessing life expectancy
-b
case
65-year-old pedestrian was hit by falling and suffering a head injury, abdominal and lower leg.
On examination GCS 9, breathing 35 times per minute, blood pressure of 80 mmHg systolic,
CT scan of the head showed a small subdural hematome with swelling in the left parietal lobe
there is a large liver laceration but no other intra-abdominal trauma.
Radiological: showed the lower limbs dislocated and fractured in both proximal tibia
RTS
GCS = 9 ; code value of 3 X 0.9368 = 2.8104
Respiratory rate = 35 code value of 3 X 0.7326 =
2.1978
Total RTS = 5.8806
RTS value of 5.8806 means that the general
state of the patient is critical.
ISS
Components AIS
small subdural hematoma; 4
swelling in the left parietal lobe; 3
extensive liver laceration; 4
tibia fracture / dislocation 3
ISS = 4 + 4 + 3 = 41
ISS value of 41 obtained from 2 severe injuries and 1 critical injury means an injury sustained is severe
2 2 2
PROBABILITY OF SURVIVAL = PS
Coefficient SOURCE OF DATA BLUNT TRAUMA
from TRAUMA NETWORK is:
b0 = 0,5600
b1 = 0,7281
b2 = - 0,1132
b3 = 0,8339
b= 0,56+(0,7281)(5,8806)+(-0,1132)941)+(-
0,8339)(1)
PS = 1/(1 + e ) = 0,1634 = 16 %
PS value of 16% means survival rate is also 16%
TRISS method;
when PS is more than 0.5 , the patient survival is expressed as EXPECTED SURVIVAL and
if the patient died, it is indicated as TREATMENT FAILURE.
when PS is less than or equal to 0.5, and the patient died, it is expressed as EXPECTED DEATH
if the person lives it is declared as the SUCCESS OF THERAPY.
-b
MATERIALS AND METHODS
the accuracy of TRISS method as
diagnostic test in determining life
expectancy in multiple trauma from
December 2012 to May 2013,
100 patients were counted by using
TRISS Methods which consist of
RTS, ISS and PS
DATA ANALYSIS
Based on TRISS methods The Data was analyzed by using
SPSS software to calculate the sensitivity, specificity and accuracy in determining the possibility of life expectancy
It also calculated the magnitude of therapeutic failure and therapeutic success by using the formula
Positive predictive value = X 100%
EXPECTED SURVIVAL
Negative predictive value = X 100%
expected dead
Therapeutic failure = X 100%
Therapeutic success = X 100%
a
a + b
d
c + d
b
a + b
c
c + d
RESULTS AND DISCUSSION
patients aged between 1.0 to 69.0 years old,
with a mean of 30.8 years old, generally aged
16-45 years old (68%),
men (88%) are more than women (22%)
The cause of trauma generally due to traffic
accidents by 69.0%, mostly caused by blunt
trauma (thoracic and abdominal, pelvic fracture,
perineal trauma ) and head trauma (86.0%) is
the leading cause of death in this study
From the characteristics analyzed, the patient
outcomes is found to be no significant difference
(p> 0.05) based on patient characteristics
consisting of age, sex, type of trauma and the
cause of trauma
There is no significant difference in outcome (p>
0.05) based on the type and speed of action.
The life expectancy is analyzed by the TRISS method for the patient outcome.
It is predicted the patient lives when PS > 0.5, and the patient dies when PS < 0.5.
Three of the patients had PS < 0.5 and all of them were died.
97 multiple trauma patients have PS > 0.5 and 9 of them died,
meaning that therapeutic failure was found in 9 from the 97 patients (9.3%)
Outcome
Predictions of
life expectancy
Live
N (%)
Die
N (%)
Total
N (%)
PS > 0.5 (live) 88 (90.7%)
(100.0%)
9 (9.3%)
(75%)
97 (100%)
(97.0)
PS < 0.5 (die) 0 (0.0%)
(0.0%)
3 (100%)
(25.0%)
3 (100.0%)
(3.0%)
TOTAL 88 (88.0%)
(100.0%)
12 (12.0%)
(100.0%)
100 (100.0%)
(100.0%)
Primary data.
Generally be calculated sensitivity 88.0%,
Specificity of 25.0%,
Accuracy of 91.0%,
Expected survival of 90.7%;
Death expected value of 100%;
Therapeutic failure of 9.3%
and 0.0% of therapeutic success.
CONCLUSIONS:
the results of this study indicate that the TRISS method has accuracy, sensitivity, expected survival and expected death is quite high, but lack of specificity.
TRISS method is more accurate in predicting death than possibility of alive
TRISS method should be used for the prediction of outcome in multiple trauma patients at each hospital to help doctors and medical staff in order to make a more precise prognostic in each multiple trauma patients
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